This reading group guide for Do No Harm includes an introduction, discussion questions, and ideas for enhancing your book club. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book

Introduction

From the USA Today bestselling author of Behind Every Lie and The Night Olivia Fell comes an unforgettable and heart-wrenching novel about the lengths one woman will go to save her son.

Emma loves her life. She’s the mother of a precocious kindergartener, married to her soulmate—a loyal and loving police detective—and has a rewarding career as a doctor at the local hospital.

But everything comes crashing down when her son, Josh, is diagnosed with a rare form of cancer.

Determined to save him, Emma makes the risky decision to sell opioids to fund the lifesaving treatment he needs. But when somebody ends up dead, a lethal game of cat and mouse ensues, her own husband leading the chase. With her son’s life hanging in the balance, Emma is dragged into the dark world of drugs, lies, and murder. Will the truth catch up to her before she can save Josh?

A timely and moving exploration of a town gripped by the opioid epidemic, and featuring Christina McDonald’s signature “complex, emotionally intense” (Publishers Weekly) prose, Do No Harm examines whether the ends ever justify the means . . . even for a desperate mother.

Topics & Questions for Discussion

1. Emma often reflects on her dad’s advice, including “You don’t get to choose which cards you’re dealt”; “Sometimes you’re dealt a losing hand, and that really sucks. But if you always fold, you’ll have a pretty tough time in life”; “Keep your hand close to your chest”; and “Never get caught drawing dead.” In which instances in the book do you think Emma uses this advice to justify her actions?

2. Throughout the book McDonald paints the opioid epidemic as a complex problem. Her characters recognize that opioids can provide lifesaving pain relief, but that they can also cause lifelong addiction that endangers people. When Emma discovers that her colleague and friend Julia has been stealing opioids, she thinks, “[Addicts] needed help, not criticism and ridicule.” How does Emma’s opinion of using opioids for pain management evolve?

3. Nate once said of Josh and Emma, “You need him as much as he needs you.” Do you think this is an accurate assessment of their relationship as mother and son? Why or why not?

4. When Emma encounters someone from Moira’s church who expresses her sympathy for Josh and their family, Emma has a particularly negative reaction: “Thoughts and prayers. . . . Like that does any good.” Why do you think she has that reaction to the church’s response to Josh’s illness?

5. When Emma visits Julia and sees her in pain, Julia tells her, “I’m not an addict. Maybe I’m addicted, but I’m not an addict.” What do you think the difference is for Julia? Compare her addiction to that of other characters in the story, such as Ben or Violeta.

6. Nate often feels pressure to provide for his family, at times relying on traditional roles of masculinity and, in moments of failure, thinking, “What kind of man was he?” Why do you think Nate has this idea of fatherhood? How do you think Nate’s vision of fatherhood drives his actions?

7. Emma states that her job as a doctor is “to help people, not watch them suffer.” However, at times Emma’s actions cause her to do both. Discuss points when Emma’s actions cause unintended pain or suffering.

8. When thinking about her brother, Ben, and the anger and resentment that he developed during his life, Emma asks herself, “What makes people go to war with themselves?” What are the reasons that the characters in this book “go to war with themselves”? What commonalities do you think Ben and Emma have as siblings?

9. In Do No Harm, the family receives some small donations through a GoFundMe account set up to help pay for Josh’s treatments. Do you think GoFundMe accounts and community donations should play a role in paying for medical care?

10. Do you agree with Emma that “the ends justify the means”? Why or why not?

11. One of the overarching themes in Do No Harm is sacrifice. Emma sacrifices her oath as a doctor to save her son’s life. Nate sacrifices his life to protect his wife. Discuss other sacrifices that characters make. Which do you think are justified?

12. Did Emma’s final choice surprise you? Why or why not?

Enhance Your Book Club

1. In 2017, the Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency in the United States. Research the interventions the government is currently taking and discuss the different means of intervention. Do you think these interventions are working?

2. In Do No Harm, Josh’s leukemia diagnosis forces his family to take extreme measures in order to afford his treatments. Is there someone in your community who is facing similar circumstances? With your book group, organize a donation to their GoFundMe to help provide some support.

3. Author Christina McDonald captures many of the complexities of the opioid epidemic. Did the book change the way you view opioid addiction? Why or why not?